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typhoid vaccine (Vivotif Bernia)
Indications:
- promotes active immunity to typhoid fever for patients exposed to a typhoid carrier or foreign travel to endemic area (80% effective in children under 5) [1]
- herd immunity effect (44% effective) [1]
- typhoid conjugate vaccine recommended for infants & children > 6 months of age in typhoid-endemic countries (WHO) [5]
Contraindications:
1) acute infection
2) previous sensitivity to typhoid vaccine
3) previous adverse reaction to parenteral typhoid vaccine is not a contraindication to use of oral vaccine
Caution:
- use in pregnancy & immunodeficiency only when clearly needed
Dosage:
Oral: typhoid live virus vaccine
1) adults & children > 6 years of age
2) primary immunization:
a) one capsule on alternate days (4 capsules)
b) take 1 hour after meals with water
3) booster: repeat primary schedule at 5 year intervals
Parenteral: typhoid polysaccharide vaccine
1) primary immunization (Typhim Vi)
a) adults & children >= 2 years of age
b) 25 ug (0.5 mL) IM
2) booster: repeat at 2 year intervals
Pharmacokinetics:
Oral: Onset of immunity within 1 week; duration 5 years.
Injection:
1) primary vaccination may be accomplished with a single injection
2) duration of immunity 2 years
Adverse effects:
oral
1) most common (1-10%)
- abdominal discomfort, stomach cramps, diarrhea, nausea/ vomiting, skin rash
2) uncommon (<1%)
- anaphylactic reaction
injection
1) common (> 10%)
- local tenderness, pain, erythema, malaise
2) less common (1-10%)
- induration, myalgia, nausea, headache
Drug interactions:
1) avoid simultaneous administration of other vaccines which may cause local or systemic reactions
2) systemic antibiotics & antimalarials may inhibit vaccine response
Related
typhoid (enteric) fever
Specific
typhoid conjugate vaccine
typhoid live virus vaccine (Vivotif)
typhoid polysaccharide vaccine (Typhim VI)
General
vaccine
References
- Sur D et al.
A cluster-randomized effectiveness trial of Vi typhoid
vaccine in India.
N Engl J Med 2009 Jul 23; 361:335
PMID: 19652547
- Levine MM.
Typhoid vaccines ready for implementation.
N Engl J Med 2009 Jul 23; 361:403
PMID: 19625721
- Jackson BR et al
Updated Recommendations for the Use of Typhoid Vaccine -
Advisory Committee on Immunization Practices, United States,
2015.
MMWR Weekly. March 27, 2015 / 64(11);305-308.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6411a4.htm
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Department of Veterans Affairs, VA National Formulary
- World Health Organization (WHO). April 3, 2018
WHO recommends use of first typhoid conjugate vaccine.
http://www.who.int/immunization/newsroom/press/who_recommends_use_first_typhoid_conjugate_vaccine/en/